Differences in Cardiovascular Health at the Intersection of Race, Ethnicity, and Sexual Identity.

Importance: An understanding of the intersectional effect of sexual identity, race, and ethnicity on disparities in cardiovascular health (CVH) has been limited. Objective: To evaluate differences in CVH at the intersection of race, ethnicity, and sexual identity using the American Heart Association's Life's Essential 8 measure. Design, Setting, and Participants: This cross-sectional study was conducted from July 27 to September 6, 2023, using National Health and Nutrition Examination Survey data from 2007 to 2016. Participants were noninstitutionalized, nonpregnant adults (aged 18-59 years) without cardiovascular disease or stroke. Exposures: Self-reported sexual identity, categorized as heterosexual or sexual minority (SM; lesbian, gay, bisexual, or "something else"), and self-reported race and ethnicity, categorized as non-Hispanic Black (hereafter, Black), Hispanic, non-Hispanic White (hereafter, White), and other (Asian, multiracial, or any other race and ethnicity). Main Outcome and Measures: The primary outcome was overall CVH score, which is the unweighted mean of 8 CVH metrics, assessed from questionnaire, dietary, and physical examination data. Regression models stratified by sex, race, and ethnicity were developed for the overall CVH score and individual CVH metrics, adjusting for age, survey year, and socioeconomic status (SES) factors. Results: The sample included 12 180 adults (mean [SD] age, 39.6 [11.7] years; 6147 [50.5%] male, 2464 [20.2%] Black, 3288 [27.0%] Hispanic, 5122 [42.1%] White, and 1306 [10.7%] other race and ethnicity). After adjusting for age, survey year, and SES, Black (ß, -3.2; 95% CI, -5.8 to -0.6), Hispanic (ß, -5.9; 95% CI, -10.3 to -1.5), and White (ß, -3.3; 95% CI, -6.2 to -0.4) SM female adults had lower overall CVH scores compared with their heterosexual counterparts. There were no statistically significant differences for female adults of other race and ethnicity (ß, -2.8; 95% CI, -9.3 to 3.7) and for SM male adults of any race and ethnicity compared with their heterosexual counterparts (Black: ß, 2.2 [95% CI, -1.2 to 5.7]; Hispanic: ß, -0.9 [95% CI, -6.3 to 4.6]; White: ß, 1.5 [95% CI, -2.2 to 5.2]; other race and ethnicity: ß, -2.2 [95% CI, -8.2 to 3.8]). Conclusions and Relevance: In this cross-sectional study, CVH differed across race and ethnicity categories in SM females, suggesting that different communities within the larger SM population require tailored interventions to improve CVH. Longitudinal studies are needed to identify the causes of CVH disparities, particularly in Black and Hispanic SM females and inclusive of other racial and ethnic identities.

Sexual minority health and allostatic load in the National Health and Nutrition Examination Survey: A systematic scoping review with intersectional implications.

Understood largely from a minority stress framework, sexual minorities (SM) are hypothesized to suffer more physical and mental health burdens compared to their heterosexual counterparts. Several studies have used data from the National Health and Nutrition Examination Survey (NHANES) in the United States to assess SM health disparities and the 'wear and tear' of allostatic load. Because findings are generally mixed and sometimes contradictory with sexual minority stress theory, we endeavoured to explore existing NHANES studies of SM health. Our scoping review yielded a comprehensive analysis of all existing published articles (N = 43) that have used the NHANES to assess any outcome regarding SM health and well-being. Our synthesis confirms that SM sub-groups are significantly different from one another and from their heterosexual peers on several key health variables. Surprisingly, gay men appear to have the lowest allostatic load and no differences have yet been identified among women as a function of sexual identity/behavior. The existing literature suggests a need to use the NHANES more broadly and to include more psychosocial variables to better delineate sexual minority stress. This is especially important to consider at a physiological level in allostatic load research that should better include health behaviors available in NHANES and from other available datasets as moderators linking psychosocial exposures (e.g., minority stress) and health outcomes. Suggested future directions are proposed in an intersectional perspective that incorporates interactions among sex, gender, sexual identity/behaviors, race, ethnicity, age cohorts, socioeconomic status, and lived experiences.

Federal requirements for nursing homes to include certified nursing assistants in resident care planning and interdisciplinary teams: A policy analysis.

Starting in 2016, Centers for Medicare and Medicaid Services implemented the first phase of a 3-year multi-phase plan revising the manner in which nursing homes are regulated. In this revision, attention was placed on the importance of certified nursing assistants (CNAs) to resident care and the need to empower these frontline workers. Phase II mandates that CNAs be included as members of the nursing home interdisciplinary team that develops care plans for the resident that are person-centered and comprehensive and reviews and revises these care plans after each resident assessment. While these efforts are laudable, there are no direct guidelines for how to integrate CNAs in the interdisciplinary team. We recommend the inclusion of direct guidelines, in which this policy revision clarifies the expected contributions from CNAs, their responsibilities, their role as members of the interdisciplinary team, and the expected patterns of communication between CNAs and other members of the interdisciplinary team.

Differences in Multimorbidity among Cisgender Sexual Minority and Heterosexual Adults: Investigating Differences across Age-Groups.

Objectives: Despite increased risk for chronic disease, there is limited research that has examined disparities in multimorbidity among sexual minority adults and whether these disparities differ by age. Methods: Data were from the 2014-2018 Behavioral Risk Factor Surveillance System. We used sex-stratified multinomial logistic regression to examine differences in multimorbidity between sexual minority and heterosexual cisgender adults and whether hypothesized differences varied across age-groups. Results: The sample included 687,151 adults. Gay, lesbian, and bisexual adults had higher odds of meeting criteria for multimorbidity than same-sex heterosexual adults. These disparities were greater among sexual minority adults under the age of 50 years. Only other non-heterosexual men over the age of 50 years and lesbian women over the age of 80 years were less likely to have multimorbidity than their same-sex heterosexual counterparts. Discussion: Health promotion interventions to reduce adverse health outcomes among sexual minorities across the life span are needed.

Mobile Electrocardiogram Monitoring and Health-Related Quality of Life in Patients With Atrial Fibrillation: Findings From the iPhone Helping Evaluate Atrial Fibrillation Rhythm Through Technology (iHEART) Study.

BACKGROUND: Atrial fibrillation (AF) is associated with high recurrence rates and poor health-related quality of life (HRQOL) but few effective interventions to improve HRQOL exist. OBJECTIVE: The aim of this study was to examine the impact of the "iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology" (iHEART) intervention on HRQOL in patients with AF. METHODS: We randomized English- and Spanish-speaking adult patients with AF to receive either the iHEART intervention or usual care for 6 months. The iHEART intervention used smartphone-based electrocardiogram monitoring and motivational text messages. Three instruments were used to measure HRQOL: the Atrial Fibrillation Effect on Quality of Life (AFEQT), the 36-item Short-Form Health survey, and the EuroQol-5D. We used linear mixed models to compare the effect of the iHEART intervention on HRQOL, quality-adjusted life-years, and AF symptom severity. RESULTS: A total of 238 participants were randomized to the iHEART intervention (n = 115) or usual care (n = 123). Of the participants, 77% were men and 76% were white. More than half (55%) had an AF recurrence. Both arms had improved scores from baseline to follow-up for AFEQT and AF symptom severity scores. The global AFEQT score improved 18.5 and 11.2 points in the intervention and control arms, respectively (P < .05). There were no statistically significant differences in HRQOL, quality-adjusted life-years, or AF symptom severity between groups. CONCLUSIONS: We found clinically meaningful improvements in AF-specific HRQOL and AF symptom severity for both groups. Additional research with longer follow-up should examine the influence of smartphone-based interventions for AF management on HRQOL and address the unique needs of patients diagnosed with different subtypes of AF.

An intersectional approach to examine sleep duration in sexual minority adults in the United States: findings from the Behavioral Risk Factor Surveillance System.

OBJECTIVES: Investigate sexual identity differences in sleep duration and the multiplicative effect of sexual identity and race/ethnicity among US adults. DESIGN: Cross-sectional. PARTICIPANTS: The sample consisted of 267,906 participants from the Behavioral Risk Factor Surveillance System. MEASUREMENTS: Sleep duration was categorized as very short (≤4 hours), short (5-6 hours), adequate (7-8 hours), or long (≥9 hours). Sex-stratified multinomial logistic regressions were used to examine sexual identity differences in sleep duration. We then examined sleep duration by comparing sexual minorities to (1) same-race/-ethnicity heterosexuals and (2) White participants with the same sexual identity. RESULTS: Sexual minority women had higher odds of very short sleep compared to heterosexual women, regardless of race/ethnicity. Black gay men had higher rates of very short sleep but lower rates of long sleep relative to Black heterosexual men. Latino and Asian/Pacific Islander bisexual men reported higher rates of short sleep than their heterosexual counterparts. Black lesbian and other-race bisexual women were more likely to have very short sleep than their heterosexual peers. Black lesbian women also had higher rates of long sleep. Analyses examining racial/ethnic differences by sexual identity found that Black and Latino gay men reported higher rates of very short sleep compared to White gay men. Black bisexual women had higher rates of short sleep duration than White bisexual women. CONCLUSIONS: More research is needed to understand how to promote sleep health among sexual minorities, particularly racial/ethnic minorities, and the impact of inadequate sleep duration on health outcomes in this population.

Care of LGBTQ older adults: What geriatric nurses must know.

Geriatric nurses have a responsibility to promote the health of all older adults. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are particularly vulnerable to poor health outcomes and are less likely to seek healthcare due to fear of discrimination. Despite elevated risk LGBTQ older adults are often ignored within geriatric nursing as there is little evidence to inform care. To adequately care for LGBTQ patients geriatric nurses should recognize the effects of bias, appreciate the importance of terminology, understand diversity within the LGBTQ community, advocate for the inclusion of sexual orientation and gender identity in admission assessments, share best practices, and advocate for increased visibility. Caring for this population may be challenging, as it will require geriatric nurses to expand their knowledge of LGBTQ health, explore their own biases, and challenge institutional norms. However, through coordinated efforts geriatric nurses can work toward improving care for LGBTQ older adults.

A scoping review of sexual minority women's health in Latin America and the Caribbean.

OBJECTIVES: Despite research documenting significant health disparities among sexual minority women (lesbian, bisexual, and other non-heterosexual women) in high-income countries, few studies of sexual minority women's health have been conducted in low- and middle-income countries. The purpose of this scoping review was to examine the empirical literature related to the health disparities and health needs of sexual minority women in Latin America and the Caribbean (LAC), and to identify research gaps and priorities. DESIGN: A scoping review methodology was used. DATA SOURCES: We conducted a comprehensive search of seven electronic databases. The search strategy combined keywords in three areas: sexual minority women, health, and LAC. English, Spanish, and Portuguese language studies published through 2017 in peer-reviewed journals were included. REVIEW METHODS: A total 1471 articles were retrieved. An additional 5 articles were identified following descendancy search; 3 of these met inclusion criteria. After removal of duplicates and title and abstract screening, we screened the full text of 37 articles, of which 22 (representing 18 distinct studies) met inclusion criteria. At least two authors independently reviewed and abstracted data from all articles. RESULTS: More than half of the studies were conducted in Brazil (n = 9) and Mexico (n = 5). Sexual health was the most studied health issue (n = 11). Sexual minority women were at elevated risk for sexually transmitted infections related to low use of barrier contraceptive methods during sexual encounters with men. Findings suggest that sexual minority women are generally distrustful of healthcare providers and view the healthcare system as heteronormative. Providers are believed to lack the knowledge and skills to provide culturally competent care to sexual minority women. Sexual minority women generally reported low levels of sexual health education and reluctance in seeking preventive screenings due to fear of mistreatment from healthcare providers. Sexual minority women also reported higher rates of poor mental health, disordered eating, and substance use (current tobacco and alcohol use) than heterosexual women. Gender-based violence was identified as a significant concern for sexual minority women in LAC. CONCLUSIONS: Significant knowledge gaps regarding sexual minority women's health in LAC were identified. Additional investigation of understudied areas where health disparities have been observed in other global regions is needed. Future research should explore how the unique social stressors sexual minority women experience impact their health. Nurses and other healthcare providers in the region need training in providing culturally appropriate care for this population.

Cardiovascular Disease Disparities in Sexual Minority Adults: An Examination of the Behavioral Risk Factor Surveillance System (2014-2016).

PURPOSE: Investigate sexual orientation differences in cardiovascular disease risk and cardiovascular disease. DESIGN: Cross-sectional. SETTING: The 2014 to 2016 Behavioral Risk Factor Surveillance System. PARTICIPANTS: A total of 395 154 participants. MEASURES: The exposure measure was sexual orientation. Self-report of cardiovascular disease risk factors and cardiovascular disease was assessed. ANALYSIS: Sex-stratified logistic regression analyses to examine sexual orientation differences in cardiovascular disease risk and cardiovascular disease (heterosexuals = reference group). RESULTS: Sexual minority men reported higher rates of mental distress (gay adjusted odds ratio [AOR]: 1.59; bisexual AOR: 1.88) and lifetime depression (gay AOR: 2.48; bisexual: AOR 2.67). Gay men reported higher rates of current smoking (AOR: 1.28), but lower rates of obesity (AOR: 0.82) compared to heterosexual men. Sexual minority women reported higher rates of several cardiovascular risk factors including mental distress (lesbian AOR: 1.37; bisexual AOR: 2.33), lifetime depression (lesbian AOR: 1.96; bisexual AOR: 3.26), current smoking (lesbian AOR: 1.65; bisexual AOR: 1.29), heavy drinking (lesbian AOR: 2.01; bisexual AOR: 2.04), and obesity (lesbian AOR: 1.50; bisexual AOR: 1.29), but were more likely to exercise than heterosexual women (lesbian AOR: 1.34; bisexual AOR: 1.24). Lesbian women reported lower rates of heart attack (AOR: 0.62), but bisexual women had higher rates of stroke than heterosexual women (AOR: 1.46). CONCLUSIONS: Findings can inform the development of prevention efforts to reduce cardiovascular disease risk in sexual minorities.

Sexual Orientation Differences in Modifiable Risk Factors for Cardiovascular Disease and Cardiovascular Disease Diagnoses in Men.

PURPOSE: Despite higher rates of modifiable risk factors for cardiovascular disease (CVD) in gay and bisexual men, few studies have examined sexual orientation differences in CVD among men. The purpose of this study was to examine sexual orientation differences in modifiable risk factors for CVD and CVD diagnoses in men. METHODS: A secondary analysis of the National Health and Nutrition Examination Survey (2001-2012) was conducted. Multiple imputation was performed for missing values. Differences across four distinct groups were analyzed: gay-identified men, bisexual-identified men, heterosexual-identified men who have sex with men (MSM), and heterosexual-identified men who denied same-sex behavior (categorized as exclusively heterosexual). Multiple logistic regression models were run with exclusively heterosexual men as the reference group. RESULTS: The analytic sample consisted of 7731 men. No differences between heterosexual-identified MSM and exclusively heterosexual men were observed. Few differences in health behaviors were noted, except that, compared to exclusively heterosexual men, gay-identified men reported lower binge drinking (adjusted odds ratio [AOR] 0.58, 95% confidence interval [CI] = 0.37-0.85). Bisexual-identified men had higher rates of mental distress (AOR 2.39, 95% CI = 1.46-3.90), obesity (AOR 1.69, 95% CI = 1.02-2.72), elevated blood pressure (AOR 2.30, 95% CI = 1.43-3.70), and glycosylated hemoglobin (AOR 3.01, 95% CI = 1.38-6.59) relative to exclusively heterosexual men. CONCLUSIONS: Gay-identified and heterosexual-identified MSM demonstrated similar CVD risk to exclusively heterosexual men, whereas bisexual-identified men had elevations in several risk factors. Future directions for sexual minority health research in this area and the need for CVD and mental health screenings, particularly in bisexual-identified men, are highlighted.

Implications of the CARE Act for Latino Caregivers.

The Caregiver Advise, Record, Enable (CARE) Act has the potential to make a positive impact in the lives of Latino older adults and their caregivers. As Latino individuals are the fastest growing older adult population, the number of Latino families and caregivers is also expected to grow, particularly among those providing care for someone with Alzheimer's disease or other dementias. Caregiving has been considered a culturally embedded value among Latino individuals. Although few studies have focused on caregiving in this population, those that exist suggest that Latino caregivers struggle to find bilingual and bicultural support and information and show higher levels of distress and health disparities. The purpose of the CARE Act is to help and support family caregivers when older adults are admitted to the hospital and during care transitions. The current article examines the potential implications of this state law, specifically on Latino individuals, including recommendations for policy implementation. [Journal of Gerontological Nursing, 44(3), 9-14.].

Successful ageing in lesbian, gay and bisexual older people: a concept analysis.

AIMS AND OBJECTIVES: The aim of this study was to report on an analysis of the concept of successful ageing in lesbian, gay and bisexual older people. BACKGROUND: Research indicates that lesbian, gay and bisexual older people experience significant health disparities. Yet there is a lack of understanding on what factors contribute to successful ageing in this population. Nursing has lagged behind other disciplines in investigating the health of lesbian, gay and bisexual older people. DESIGN: A concept analysis using Rodgers' evolutionary method. DATA SOURCES: Twenty studies were retrieved by searching PubMed, CINAHL, PsycInfo, EMBASE, Cochrane Library and Scopus for English-language peer-reviewed studies published from January 2004 to March 2014. METHODS: The antecedents, attributes and consequences of the concept were identified through the Rodgers' method of concept analysis. RESULTS: Attributes included support from families of origin and/or families of choice, access to lesbian, gay, and bisexual-friendly services and crisis competence. Self-realisation of lesbian, gay and bisexual identity (coming out to oneself) and age >50 were identified as antecedents. Three consequences of successful ageing in lesbian, gay and bisexual older people were social engagement, optimism and resilience. CONCLUSION: Successful ageing in lesbian, gay and bisexual older people is defined as a subjective and multifactorial concept that is characterised by support from families of origin/families of choice, access to lesbian, gay, and bisexual-friendly services and the development of crisis competence skills which impact the ageing experience of LGB individuals. IMPLICATIONS FOR PRACTICE: Successful ageing models can provide a roadmap for developing culturally competent interventions to address key healthcare issues present in this population. The nursing profession's multidisciplinary knowledge and competence in providing health promotion makes nurses well positioned to take a leading role in reducing disparities of lesbian, gay and bisexual older people.

Policy implications of a literature review of bariatric surgery in older adults.

In the past decade, bariatric surgery has garnered attention as a treatment for obesity in older adults. Its increased popularity is a direct response to growing obesity rates in this segment of the population. Bariatric surgery among older adults has emerged as a contentious issue debated by federal and state governments, health care providers, and patients. It is important for geriatric nurses to comprehend the policy and health implications of bariatric surgery for older adults. The purpose of this paper is to (a) discuss the burden of growing obesity rates on the health of older adults, (b) present the results of a literature review of bariatric surgery outcomes in older adults, and (c) evaluate the policy implications of insurance coverage of bariatric procedures.